On June 19, Liu Bing, Vice President of the Cardiology Hospital of Xi'an International Medical Center Hospital, led a team to successfully remove a pacemaker with a ruptured capsule for a patient with Bricella. The patient has now been transferred back to a local hospital for rehabilitation.
Pus and ulceration A pacemaker implanted 11 years ago "drilled" out of the body
Under her left collarbone, she has a bumpy ulcer of skin that exposes the pacemaker she implanted 11 years ago, which is connected to a pacing electrode that extends into the heart to support a heartbeat at a rate of 60 beats per minute.
One month ago, the tissue around the pacemaker became infected, and the pouch "broke out". Anti-infective treatment was tried at the local hospital, but it was not effective. On the recommendation of the director of the cardiology department of the local hospital, Jia Fang took the train overnight to find Liu Bing.
2 hospital-wide multidisciplinary consultations and 6 family interviews
The pacemaker has been with the 70-year-old Jia Fang for 11 years, and after six conversations, Jia Fang vowed to remove the "evil". The pacemaker electrode is closely adhered to the blood vessels and the intima of the surrounding tissues, and when the pacing electrode is pulled out in the myocardium, it is like pulling out the radish to bring out the mud, and the risk of blood vessel tearing, heart rupture, and perforation is extremely high, and there are only a handful of hospitals that have the ability, willingness to take risks, and can carry out this technology, plus the patient has a class B infectious disease - brucellosis, it is not easy to safely remove the pacemaker.
If it is surgically removed, how? What special surgical instruments are needed? In which operating room? How to protect against the risk of nosocomial infection of Class B infectious diseases? What are the plans for the risks encountered during the operation? Liu Yantong, Vice President of Xi'an International Medical Center Hospital, Zhang Bin, Vice President, Feng Junqiang, Director of the Department of Medical Education, and Liu Bing, Director of the Infection Control Office, participated in the consultation, Wang Haichang, President of the Heart Hospital, Li Weijie, Executive Dean, Su Yingjun, Director of the Wound and Scar Prevention and Treatment Center of the Plastic Surgery Hospital, Yang Jinbao, Deputy Chief Physician of the Department of Cardiac Surgery, Zhang Yutao, Deputy Chief Physician of the Department of Anesthesiology and Surgery, and many experts from the Department of Infectious Diseases, Ultrasound Diagnosis and Treatment Department, Blood Transfusion Department, and Department of Pharmacy consulted and refined to each link. A surgical plan to completely remove the infected wound and capsular pocket, and then remove the ventricular atrial pacing electrodes one by one.
222 minutes of life and death appointments inside and outside the operating room
An operation is a life-and-death appointment between doctors and patients, and behind it is the linkage of multiple departments in the whole hospital.
"The spare machine in the anesthesiology surgery department has been commissioned!"
"The DSA operating room has been sanitized in accordance with the infection control requirements!"
"The Department of Cardiac Surgery has prepared cardiopulmonary bypass equipment and the personnel are in place!"
"Blood transfusion department has prepared blood!"
In the operating room, Liu Bing, Su Yingjun, who were wearing lead suits, N95 masks, and protective face shields, and Wu Feng, a surgical assistant, "faced the enemy head-on".
Outside the operating room, the medical staff on the table have been dressed and can take over the thoracotomy intervention at any time. Li Weijie "supervised" next to the DSA monitor, and never took his eyes off the screen.
In the screen, the part of the pacemaker infected with bacteria was peeled off layer by layer, a surgical field with a surface hard like an eggshell was exposed, and there was a repeatedly infected abscess cavity under the wound, which constantly produced purulent secretions.
The procedure was more difficult than expected, taking 1 hour alone, and if the debridement was not complete, the follow-up work would be in vain.
In contrast, the separation process is not intuitive, and the surgery relies heavily on the doctor's experience and "feel". The pacing electrode is too tightly adhered to the blood vessels, Liu Bing holds the locking probe with one hand to anchor the pacing electrode to establish an "orbit", and with the other hand, the mechanical expansion sheath is probed forward little by little to separate the fibrous tissue adhered along the electrode wire.
"Remove both pacing electrodes completely." In 222 minutes, a silent high-risk and high-difficulty "battle" came to an end in the operating room of DSA.
As one of the first cardiovascular experts in China to carry out pacemaker implantation and removal, Liu Bing said that the department has always been patient-centered, synchronized with the international advanced diagnosis and treatment level, and solved the "big problems" of patients.
Chinese business all-media reporter Chen Mengyang
According to Xi'an International Medical Center Hospital